Guest Editorial: The pain pill

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Posted on November 21, 2012 |

Prescription drug abuse is a problem with numerous casualties and it is a reality that we know only too well in St. Albans. The abuse has torn families apart, led to increases in local crime, and put many peoples’ health at risk.

But it’s also proven notoriously difficult to address and for reasons symptomatic of the challenge that confronts most health care initiatives: it’s difficult to generate a consensus behavior among health care professionals, the public’s perception of the issue is skewed, and patients would prefer to take a pill to make the pain go away rather than to consider a change in lifestyle, etc.

These issues and others were explored in a white paper put forth by the Vermont Medical Society Education and Research Foundation. The purpose of the report was to draw attention to the issue and to recommend ways to help guide practitioners and the general public.

The recommendations included:

1. Create a single set of recommendations for treating pain in Vermont

2. Improve the VPMS to help practitioners be good practitioners

3. Educate the public to expect best medical practices

4. Evaluate the approach of professional oversight

5. Differentiate the role of law enforcement from the role of care giver

6. Discourage payment policies that encourage pill prescribing

7. Innovate

What is most striking about the report is the fact that pain has become such a prevalent part of a physician’s practice and that there are very few doctors with any real training in how to properly manage pain.

Here’s one doctor’s observation:

“The treatment of non-malignant chronic pain is the most difficult problem that primary care practitioners have to deal with.”

Primary care physician

Here’s another:

“Most people don’t need to be on chronic pain medications. However, doctors went to medical school to help people and sometimes, due to lack of reimbursement for other alternative therapies and lack of time, writing a prescription to give the patient something to reduce their pain is sometimes the only and easier method to affect change. Different forms of therapy need to be equally accessible to all patients.

“Doctors have an emotional response to their patients and because of the lack of resources and treatment modalities that are not covered by insurance; the emotional response is to give a pill to help.

“After years of practicing my philosophies of treating pain have changed. Now I believe we don’t have to take away all pain; we need to think about ‘what can be tolerated?’ Treatment of pain has to change to equal functionality. How much pain can you tolerate to be functional?”

Pain and addiction specialist

And this:

“Patients don’t understand that complete pain relief is not a reasonable goal. Treatment requires behavioral modifications, exercise, weight loss and life style changes. Many patients are unwilling to try complementary alternative medicine and integrated medicine approaches. Patients and practitioners need to get away from the idea that opioids are the only route of treatment; at least not the first-line therapy. Opioids do play a role as a therapeutic alternative, but not as a first-line therapy. Patients and physicians need to be more aware of the downside of opioid therapy.”

Primary care physician

It all comes together. Patients want, and expect relief. Pharmaceutical companies create the impression that this relief comes with a pill. Doctors are in the unenviable position of having a patient in pain, wanting to help, and being part of a reimbursement system that encouraging pill writing prescriptions. And the public, particularly our youth, have the perception that all prescription drugs are safe.

It’s the perfect storm.

The report identifies some of the more obvious answers, such as trying to set up a single statewide approach to the care that should be delivered in the treatment of chronic pain. It’s equally obvious that technology could help identify the patients in need and keep portable records to prevent prescription abuse. It also makes sense to embark on public health campaign similar to the one used to discourage tobacco consumption.

But we should also push for a change in insurance procedures. It makes no sense for insurance companies to be quick to cover the cost of pills and to refuse coverage of therapies that could actually lead to a change in behavior. And, hardest of all, the general public needs to be educated as to the limited value of drugs in dealing with long-term pain. If possible, and as difficult as it may be, the better approach is to deal with the lifestyles that may contribute to the source of that pain. Where have we heard that before?